title: The dose of omeprazole required to achieve adequate intraesophageal acid suppression in patients with gastroesophageal junction specialized intestinal metaplasia and Barrett's esophagus.
abstract: BACKGROUND
  The mainstay of medical therapy for Barrett's esophagus is normalization of esophageal acid exposure with proton pump inhibitors (PPIs). However, the optimal dose and whether once daily or twice daily is required for acid suppression is unknown.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether adequate intra-esophageal acid suppression could be achieved with once daily versus twice daily omeprazole in patients with gastroesophageal specialized intestinal metaplasia (GEJSIM), short-segment (SSBE) and long-segment Barrett's esophagus (LSBE).
  
  
  METHODS
  Patients with GEJSIM and Barrett's esophagus underwent upper endoscopy with 48-h wireless pH capsule while on once daily 20 mg omeprazole for at least 1 week. If intra-esophageal acid was not adequately controlled, defined as pH value <4 for greater than 4.2 % of the time during the second 24-h period, omeprazole was increased to twice daily for 1 week and upper endoscopy with wireless pH capsule was repeated.
  
  
  RESULTS
  A total of 36 patients completed the study (10 patients had GEJSIM, 16 patients had SSBE, and 10 patients had LSBE). Normalization of intraesophageal pH was achieved in 28 patients (78 %) with once daily PPI and eight patients required twice daily PPI. There was no significant difference between the three groups in the proportion of patients requiring high dose PPI (GEJSIM 10 %, SSBE 25 %, LSBE 30 %, p = 0.526).
  
  
  CONCLUSIONS
  The majority of patients with Barrett's esophagus were controlled with once daily low dose PPI and only a minority required twice daily dosing, regardless of the length of Barrett's mucosa.
authors.affiliation: Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Watson
authors.forename: Fouad J
authors.initials: FJ
authors.lastname: Moawad
authors.forename: Ganesh R
authors.initials: GR
authors.lastname: Veerappan
authors.forename: John T
authors.initials: JT
authors.lastname: Bassett
authors.forename: Corinne L
authors.initials: CL
authors.lastname: Maydonovitch
authors.forename: John D
authors.initials: JD
authors.lastname: Horwhat
authors.forename: Roy K H
authors.initials: RK
authors.lastname: Wong
mesh_terms: D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004943:Esophagogastric Junction / Q000473:pathology*; D005745:Gastric Acidity Determination; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008679:Metaplasia; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole